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NPI Code Detail

MEDICARE: JOHN C COOK APRN,BC

MEDICARE: JOHN C COOK APRN,BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner041299381IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1L88539OTHERILMEDICARE PRIOR 7/15/2007

General Provider Information

NPI Number : 1467426445
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN C COOK APRN,BC
Provider Business Mailing Address
First Line : 421 W EXCHANGE ST
Second Line : PO BOX 268
City : FREEPORT
State : IL
Zip : 61032-4030
Country : US
Telephone Number : 815-599-7958
Fax Number :
Provider Business Practice Location Address
First Line : 1010 FAIRWAY DR
Second Line :
City : FREEPORT
State : IL
Zip : 61032-6600
Country : US
Telephone Number : 815-599-7880
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 10/20/2017

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